About Tracking Medicine
When Dr. John E. “Jack” Wennberg began investigating the delivery of health care in the United States, even he had trouble believing what he found. Yet time and time again, over the course of a career spent meticulously documenting and analyzing patterns of medical practice, he has come to the same startling conclusion: the care Americans receive depends as much on the physicians they see and hospitals they use as it does on medical science and the patient’s own preference.
Part memoir, part elegantly drawn argument, Tracking Medicine chronicles a 40-year quest to understand medical variation across the country and its implications for the health of the individual patient and the nation’s long-term economic prospects. It describes the widespread variation in the way patients with chronic illness are treated: in some parts of the country, they receive much more aggressive care – spending more days in hospitals and intensive care units and undergoing more tests and procedures, for example – than patients with the same diseases who live in communities where the pattern of practice is less aggressive. Tracking Medicine also shows that the chance of having elective surgery varies substantially from community to community.
In the face of deep skepticism from fellow physicians, Wennberg continued to accumulate data until the evidence became overwhelming. Yet even today, the central implication of his work runs contrary to conventional wisdom: more medical care is not always better. Wennberg argues that physicians do not always know what is best for their patients, nor do they know what their patients prefer. As a consequence, physicians often end up operating on the wrong patient – on those who would not want surgery if they were informed of their options and participated in the choice of treatment in a meaningful way through shared decision making. He has marshaled an array of evidence showing that the supply of medical resources often determines how patients with chronic disease are treated. And, most sobering of all, much of the care provided to Americans does nothing to improve their health.
The remedies Wennberg offers build on his research. To improve care for all Americans while controlling costs, health care must pursue four goals:
Despite the U.S. health care system’s problems, Wennberg argues that there is reason for optimism. Reducing the growth of spending will not necessarily require rationing – if by “rationing” we mean the withholding of care that patients want, and that is effective in improving outcomes. If health care reform were to achieve the four goals Wennberg recommends, all Americans could receive medical coverage without adding to our already-outsized health care tab. The book’s epilogue analyzes how The Patient Protection and Affordability Act may contribute to these goals.
Tracking Medicine offers physicians, administrators, policy makers, journalists, and patients and families an understanding of the health care system. It should be a required text for medical students, public health students, health services researchers, and others interested in evaluating medical care.